Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mrs. Kelly Hannon Nichols, LCSW-R

Individual provider Clinical Social Worker · NPI 1649640764

Mrs. Kelly Hannon Nichols, LCSW-R is a Clinical Social Worker in Fayetteville, New York. Qualified in 2001, 25 years ago. Practices as a sole proprietor. Licensed in New York.

Years since qualifying
25
Licensed in
NY
In the registry since
2015
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Practice location Address checks out

215 Dawley Rd
Fayetteville, NY 13066-2546
Phone: (315) 420-6293
Fax: (315) 637-7576
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 73070425 (NY)

Record details

NPI number1649640764
Entity typeIndividual (Type 1)
GenderFemale
Credentials LCSW-R
Sole proprietorYes
NPI enumeratedOctober 1, 2015
Last updated in NPPESOctober 1, 2015

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2001 (25 years in practice)
Accepts Medicare assignment Not indicated

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